St Johns Wort × Methadone

Severity: CRITICAL Evidence: well-established

Mechanism

St. John's wort induces CYP3A4 and P-gp, significantly increasing methadone metabolism.

Effect

Severe methadone withdrawal symptoms; subtherapeutic levels

Management

Avoid combination. Can precipitate acute withdrawal.

Source

Eich-Höchli D et al. Pharmacopsychiatry 2003

⚠️ CRITICAL INTERACTION: This combination should be AVOIDED.

Disclaimer

This interaction record is for informational purposes only and does not constitute medical advice. Always consult a healthcare provider before starting or stopping any supplement or medication.